Planet Rugby Forum

The New Science of Concussion Recovery
Breakthrough therapies are helping athletes recover from injuries previously thought untreatable. But many doctors remain unaware of the advancements.
By: Kelly Bastone Jan 9, 2015

In January 2013, 24-year-old Laura Fraser hit a tree while snowboarding at Fernie, British Columbia. Afterward, she felt a ringing in her ears that doctors attributed to a mild concussion, and within a few days she felt fine.

But then she had another, less traumatic fall in March 2014. That's when her life changed. Fraser became irritable, had difficulty concentrating, and experienced headaches that worsened with exertion. “It took me three times as long to do the things I used to do,” she recalls. Her local Nova Scotia doctors told her to avoid anything that provoked symptoms, but she didn’t recover. Instead, her mental focus became so poor that she had to drop out of school.

For decades, doctors have told concussed athletes like Fraser to rest, avoid bright lights, and limit activity. Having had one concussion places you at greater risk for another, they thought. But emerging science says that’s bunk: You can recover from a concussion, with active treatments that re-condition the injured parts of your brain.

Blame the NFL for perpetuating some of our concussion misperceptions. Highly publicized lawsuits between the NFL and former football players have raised public awareness about concussions, but they’ve also confused us. For example, concussions don’t automatically result in chronic traumatic encephalopathy, the disabling neurodegenerative disorder blamed for the deaths of former football players Mike Webster and Junior Seau.

Players represented in the lawsuits maintain that the NFL concealed the dangers resulting from head injuries. But only recently have doctors developed effective concussion assessments and treatments. “Just ten years ago, the only way coaches knew to check for concussion was to ask athletes, ‘How many fingers am I holding up?’” explains Michael “Micky” Collins, PhD, director of the University of Pittsburgh Medical Center’s Sports Medicine Concussion Program. That era of ignorance perpetuated pervasive myths about concussions, such as the need to rest in a dark room or that having one concussion puts us at greater risk for another. (It doesn’t, says Collins.) “We’ve learned a tremendous amount about this injury, and the truth is not as bad as it’s made out to be,” he says. “The reality is, it’s a treatable injury.”

UPMC and a handful of other concussion clinics across the country have developed a battery of active therapies that challenge patients’ vision, balance, and concentration. Standing on one foot, tracking a moving object, and other exercises retrain the brain and rehabilitate zones that may have shut down in response to head trauma.

Therapies are tailored to the patient’s particular symptom set, since researchers now recognize six different types of concussions: anxiety/mood; cervical, which can lead to headaches; post-traumatic migraine; ocular dysfunction; vestibular, or difficulty with balance, motion, and coordination; and cognitive/fatigue, which causes concentration issues. A person suffering from an anxiety/mood concussion, for example, might become prone to angry outbursts, while someone with ocular dysfunction might feel woozy when surrounded by moving objects.

The new therapies have an impressive success rate. Collins estimates that 90 percent of UPMC’s concussion program patients make a full, complete recovery. “With all the new research we’ve done and the nearly 200 papers we’ve helped to publish in the past decade or so, we now are able to provide proven treatments and evidence-based rehabilitation therapies,” says Collins. And treatments are still evolving. “As we see 18,000 patients a year, we get better at it.”

One of this year’s program visitors was Laura Fraser, whose concussion spanned three types (vestibular, ocular, and anxiety/mood). Her prescriptions included staring at a point on the wall while shaking her head, seeking out crowded places where people bustled around her, and focusing on objects at different distances. Her clinicians also insisted that she start exercising again. Running or biking, initially for 20 minutes a day, became part of her recovery program. “It was the opposite of what I’d been hearing for a whole year,” she says. But it worked. By December, she was symptom-free and cleared for more snowboarding.

“I could feel improvement every time I did the exercises,” says Fraser. “With the ‘just rest’ approach, I was waiting for something to happen,” she explains. By contrast, the active therapies gave her a sense of control over her injury.

Concussion specialists hope that the earlier treatment and active therapies can reduce or eliminate concussions’ long-term consequences. “The old exams missed a lot,” says Jeffrey Bytomski, DO, a concussion specialist at Duke Sports Concussion Clinic. Now, assessments combine vestibular, cognitive, and ocular testing that does a much better job of identifying concussions. “If we see patients early, we get them better, faster,” adds Collins. As with any other injured body part, the brain responds better to prompt treatment.

Science hasn’t yet confirmed whether the advances can stave off CTE and other residual, concussion-related damage to the brain. But they might. “We hope that better therapies will make a difference,” says Robert Cantu, MD, a leading CTE researcher at Boston University.

That’s why the National Football League has committed huge sums to concussion research. (A recent settlement with injured players also requires the NFL to pay money for research.) Its Head Health Challenge partnership with General Electric and Under Armour has devoted $40 million toward research and technology development to better understand, diagnose, and protect against brain injury.

For now, though, the new concussion treatments and findings from the NFL-funded research haven’t trickled down to community physicians, most of whom still espouse the “rest-and-do-nothing” strategy. “We’ve learned so much in such a short period of time that we’ve outpaced the general medical knowledge,” says Collins, explaining that most family physicians and even sports medicine specialists haven’t been trained in the emerging therapies.

To help spread the word, UPMC just launched its ReThinkConcussions initiative. The site offers information about the new treatments and includes video testimonials from the likes of Dale Earnhardt Jr., who sought treatment for concussions in 2012 and 2013 after back-to-back crashes. He attests to the healing power of the new protocols.

But until the new treatments reach local doctors, you’ve got to be an advocate for your own brain health. Here’s a quick guide to seeking a specialist’s help.

Should You Visit a Concussion Clinic?

There are two things to consider when evaluating the seriousness of your concussion: the severity and duration of your symptoms, and the number of concussions you’ve had.

Head injury symptoms that clear up overnight or within a few days shouldn’t pose a concern, experts say. Even a repeat concussion shouldn’t require a specialist’s care, so long as those effects also fade quickly. But when symptoms last weeks or more, or if they result from multiple head injuries, people should see a specialist—which, for now, may mean traveling out of state to concussions centers in Colorado, Pennsylvania, Massachusetts, or North Carolina. Visit ConcussionClinics.org to find one near you.

Infrequent concussions from skiing, snowboarding, mountain biking, and team sports are not all worrisome. “Sports where you’re rarely hit in the head are much less risky than ones where it’s routine,” says Cantu, who feels that concussions incurred during recreational action sports aren’t likely to result in later-life implications. “I’m more worried about 1,000 sub-concussive blows every year.”

fatcat wrote:Poor old Georgie North. Being looked after by a bunch of selfish incompetent cunts.

Sparked twice but all is okay.

LeinsterLion wrote:

fatcat wrote:Poor old Georgie North. Being looked after by a bunch of selfish incompetent cunts.

Sparked twice but all is okay.

fatcat wrote:

LeinsterLion wrote:

fatcat wrote:Poor old Georgie North. Being looked after by a bunch of selfish incompetent cunts.

Sparked twice but all is okay.

Sorry pal, Ireland didn't play tonight. Let's chat tomorrow or whenever.

Hong Kong wrote:I was reffing a game once when the 1/2 back got a full whack on the head, accidental, and I was berated for telling him to get off the field. The physio was a mate and he was taking instructions from the coach who was saying keep him on. I had spectators shout out "it's his decision, leave him alone" and other bullshit.
I stood my ground and ordered him off. He later was admitted to hospital....

LeinsterLion wrote:

Hong Kong wrote:I was reffing a game once when the 1/2 back got a full whack on the head, accidental, and I was berated for telling him to get off the field. The physio was a mate and he was taking instructions from the coach who was saying keep him on. I had spectators shout out "it's his decision, leave him alone" and other bullshit.
I stood my ground and ordered him off. He later was admitted to hospital....

Good on ya HK. I wonder how many berating you sheepishly thought about that fact when he was admitted.

fatcat wrote:

LeinsterLion wrote:

Hong Kong wrote:I was reffing a game once when the 1/2 back got a full whack on the head, accidental, and I was berated for telling him to get off the field. The physio was a mate and he was taking instructions from the coach who was saying keep him on. I had spectators shout out "it's his decision, leave him alone" and other bullshit.
I stood my ground and ordered him off. He later was admitted to hospital....

Good on ya HK. I wonder how many berating you sheepishly thought about that fact when he was admitted.

Hysterical and nonsensical.

Hong Kong wrote:

fatcat wrote:

LeinsterLion wrote:

Hong Kong wrote:I was reffing a game once when the 1/2 back got a full whack on the head, accidental, and I was berated for telling him to get off the field. The physio was a mate and he was taking instructions from the coach who was saying keep him on. I had spectators shout out "it's his decision, leave him alone" and other bullshit.
I stood my ground and ordered him off. He later was admitted to hospital....

Good on ya HK. I wonder how many berating you sheepishly thought about that fact when he was admitted.

Hysterical and nonsensical.

player in question was out of the game for 2 months and the following weekend came up, shook my hand and thanked me for telling him to leave. Did I save his life? Fark knows but the idiots of the side line who were yelling at me that it was not my decision (it is) were as brain dead as the player could have been had he played on and recieved another knock.

The spokesman added that the player was being kept away from rugby for the week.

Clongowes meet Belvedere College in the Leinster Schools Senior Cup semi-final on March 3rd in Donnybrook Stadium.

Duff Paddy wrote:Clongowes could be in the shit here - the SCT captain hooker Moloney clearly sparked here from 50seconds. The Clongowes medical staff said he showed no signs of concussion. A relative of his then took him off the pitch and brought him to hospital, where he was allegedly diagnosed as concussed.

http://www.irishtimes.com/sport/rugby/s ... -1.2109663

The spokesman added that the player was being kept away from rugby for the week.

Clongowes meet Belvedere College in the Leinster Schools Senior Cup semi-final on March 3rd in Donnybrook Stadium.

Duff Paddy wrote:Clongowes could be in the shit here - the SCT captain hooker Moloney clearly sparked here from 50seconds. The Clongowes medical staff said he showed no signs of concussion. A relative of his then took him off the pitch and brought him to hospital, where he was allegedly diagnosed as concussed.

http://www.irishtimes.com/sport/rugby/s ... -1.2109663

The spokesman added that the player was being kept away from rugby for the week.

Clongowes meet Belvedere College in the Leinster Schools Senior Cup semi-final on March 3rd in Donnybrook Stadium.

CM11 wrote:There's two separate incidents in that article, Duff. Nowhere does it say Moloney went to hospital or was taken off by a relative.

LeinsterLion wrote:

CM11 wrote:There's two separate incidents in that article, Duff. Nowhere does it say Moloney went to hospital or was taken off by a relative.

Actually, you are right. Very oddly/badly written piece now that I've read it and comes across as a bit of a witch hunt to base an entire piece around a single clip from a schools game. Even without the context though, the footage doesn't look good.

Toulon's Not Toulouse wrote:I'd contribute something, but i seem to have forgotten what this thread was about.

DragsterDriver wrote:http://www.rugbyonslaught.com/2015/02/h ... s.html?m=1

No way players are passing this without faking low scores preseason, no way players don't have a headache.

DOB wrote:

DragsterDriver wrote:http://www.rugbyonslaught.com/2015/02/h ... s.html?m=1

No way players are passing this without faking low scores preseason, no way players don't have a headache.

When he went back to the words from the start I thought "fcuk, I'd fail now and I'm having breakfast."

The bit about having a video review of the incident available is interesting from a George North perspective.

waguser wrote:Fail for me

DragsterDriver wrote:http://www.rugbyonslaught.com/2015/02/h ... s.html?m=1

No way players are passing this without faking low scores preseason, no way players don't have a headache.

DragsterDriver wrote:

waguser wrote:Fail for me

Now imagine being game fatigued and having a smack in the face first...how does anybody pass?

LeinsterLion wrote:

DragsterDriver wrote:

waguser wrote:Fail for me

Now imagine being game fatigued and having a smack in the face first...how does anybody pass?

Don't have to be perfect though - 2 or less at the end, minimum standard and retries of the numbers. Bear in mind too that they've been removed from the field and are really concentrating.

LeinsterLion wrote:Good to see the Irish meds making an immediate decision today. No faffing about, straight away signalled that O'Brien was off.

Hong Kong wrote:

fatcat wrote:

LeinsterLion wrote:

Hong Kong wrote:I was reffing a game once when the 1/2 back got a full whack on the head, accidental, and I was berated for telling him to get off the field. The physio was a mate and he was taking instructions from the coach who was saying keep him on. I had spectators shout out "it's his decision, leave him alone" and other bullshit.
I stood my ground and ordered him off. He later was admitted to hospital....

Good on ya HK. I wonder how many berating you sheepishly thought about that fact when he was admitted.

Hysterical and nonsensical.

player in question was out of the game for 2 months and the following weekend came up, shook my hand and thanked me for telling him to leave. Did I save his life? Fark knows but the idiots of the side line who were yelling at me that it was not my decision (it is) were as brain dead as the player could have been had he played on and recieved another knock.

ehr wrote:Healy looked knocked out for a split second tbh. Thought he should have been taken off as per protocol.

mr flaps wrote:

LeinsterLion wrote:Good to see the Irish meds making an immediate decision today. No faffing about, straight away signalled that O'Brien was off.

I hate seeing lads staggering around like that. Scary stuff.

Salanya wrote:Must have been a knee or something as SOB was on the floor, didn't look like anything hit him particularly in the carry or tackle.

Well done the medics, and although it was very worrying to see him doing a bambi-impression, he walked off the field well enough by himself.